Download Guidance for healthcare professionals on drug driving July 2014

Do not remove this if sending tor Page Title
Guidance for healthcare professionals
on drug driving
July 2014
The Department for Transport has actively considered the needs of blind and
partially sighted people in accessing this document. The text will be made
available in full on the Department’s website. The text may be freely
downloaded and translated by individuals or organisations for conversion into
other accessible formats. If you have other needs in this regard please contact
the Department.
Department for Transport
Great Minster House
33 Horseferry Road
London SW1P 4DR
Telephone 0300 330 3000
Website www.gov.uk/dft
General enquiries https://forms.dft.gov.uk
© Crown copyright 2014
Copyright in the typographical arrangement rests with the Crown.
You may re-use this information (not including logos or third-party material) free
of charge in any format or medium, under the terms of the Open Government
Licence. To view this licence, visit
www.nationalarchives.gov.uk/doc/open-government-licence
or write to
the Information Policy Team, The National Archives, Kew, London TW9 4DU, or
e-mail: [email protected].
Where we have identified any third-party copyright information you will need to
obtain permission from the copyright holders concerned.
Summary
A new offence of driving with certain specified controlled drugs1 in excess of
specified levels in the body is expected to come into force on 2 March 20152. This
offence is an addition to the existing rules on drug impaired driving and fitness to
drive. The legislation also provides for a statutory “medical defence” for this new
offence, for patients taking their medicines in accordance with instructions.
In line with current professional practice, healthcare professionals prescribing or
supplying medicines take account of the risks of medicines (such as whether a
patient’s driving may be impaired by their medicines) and advise accordingly. This
clinical practice has not changed. However, healthcare professionals are likely to
want to be able to explain the new rules concerning this offence to patients.
This Department for Transport guidance document has been developed on the
advice of independent clinical experts and has been approved by the Secretary of
State's Honorary Advisory Panel on Alcohol, Drugs and Substance Misuse. It is
intended to assist healthcare professionals by clarifying key relevant information.
Background
This guidance is intended to provide healthcare professionals with:

a clear explanation of the new legislation including the statutory “medical
defence” available to patients who have taken their medicine in
accordance with the advice of a healthcare professional and/or the
information contained in the leaflet accompanying the medicine ; and

a reiteration of existing advice that healthcare professionals would
normally consider giving to patients about taking medicines that could
impair their driving.
The new drug driving offence
There is already an offence of driving whilst impaired through drugs (whether due to
non-medical use of drugs or due to legitimate use of medicines) in section 4 of the
Road Traffic Act 1988. This offence will remain in force alongside the new drug
driving offence. This offence is not new and it has not changed.
The new offence refers to driving, attempting to drive or being in charge of a vehicle
with a specified controlled drug in the body, in excess of a specified limit (Section 5A
of the Road Traffic Act 1988 as amended in April 2013). The drugs to be covered by
this offence are defined in regulations supporting the offence and are listed below.
1
2
Controlled drugs are defined in the Misuse of Drugs Act 1971
Depends upon the Regulations being approved by Parliament.
3
Roadside drug screening devices will be developed using oral fluid (saliva) to identify
if the person driving or in control of the vehicle had taken a drug as listed below (or
one that may be metabolised into one of these drugs). Following a positive
screening result using oral fluid, the person can then be requested to provide a blood
sample for evidential purposes, to enable prosecution for the new offence if above
the specified limit.
Those individuals who have taken their medicine(s) in accordance with the advice of
the prescriber or supplier of the medicine(s) (and/or the product information included
in the medicine pack) who are found to have a blood level higher than that specified
in the regulations are entitled to raise the statutory “medical defence” at any stage
(see below for full explanation), and might then not be asked to provide a blood
sample.
Impact of the new drug driving offence on patients
The types of drugs that can produce, on testing, specified controlled drugs above
specified levels, fall broadly into two groups.
The first group consists of commonly abused drugs for which low limits have been
set. This group includes certain medicines that will be taken by only a small
proportion of drivers. Given the low limits set, a patient prescribed one of these
medicines who chooses to drive could test above the specified limit but would still be
entitled to raise the statutory “medical defence”. This ‘zero tolerance’ group currently
includes:
Cannabis (THC)*
Cocaine (and a cocaine metabolite, BZE)
MDMA (Ecstasy)
Lysergic Acid Diethylamide (LSD)
Ketamine
Heroin/diamorphine metabolite (6-MAM)
Methylamphetamine
*Tetrahydrocannabinol (THC) is the active ingredient of cannabis and specified in the
regulations.
The second group consists of mainly licensed medicines that have a significant
liability to be abused, and for which the specified limits have been set at a higher
level than the first group. The higher limits are generally above the normal
therapeutic range so most patients are unlikely to be driving with a concentration of a
specified drug in their body above the specified limit. However, those on particularly
high doses, for example, could test above the specified limit and would still be
entitled to raise the statutory “medical defence”. This second group includes the
following benzodiazepines:
Clonazepam
Flunitrazepam**
Oxazepam
Diazepam
Lorazepam
Temazepam
Morphine
Amphetamine***
**No longer licenced in the UK
Plus:
Methadone
4
***Whilst amphetamine will not be included in the current regulations to go before
Parliament in 2014 it is expected to be included later in 2015 once a limit has been
agreed
The statutory “medical defence” can be raised by patients taking medicines in
accordance with instructions, from either of these two groups.
Information on whether any particular medicine is affected by the new legislation can
be found in the Summary of Product Characteristics for that medicine.
The statutory "medical defence"
This new offence does not alter in any way the clinical advice that should be given to
patients in future, which, as now, is based on a proper professional judgement for
each patient of what is the appropriate discussion concerning the risks of their
medicines.
A patient who was investigated for drug driving would generally be entitled to raise
the statutory “medical defence” if:
a. The drug was lawfully prescribed, supplied, or purchased over-the-counter,
for medical or dental purposes; and
b. The drug was taken in accordance with advice given by the person who
prescribed or supplied the drug, and in accordance with any accompanying
written instructions (so far as the latter are consistent with any advice of the
prescriber).
In relation to b above, the advice from a prescriber can be considered, patientspecific advice following assessment of the particular prescribing needs for that
individual patient. This advice can sometimes differ from the general instructions in
the medicine’s information leaflet. That healthcare professional’s advice can be then
properly used in such circumstances as a basis for the patient’s statutory “medical
defence”.
If the police had evidence that the patient's driving was impaired due to drugs,
whether prescribed or not, they can prosecute under the existing offence of driving
whilst impaired through drugs offence described in section 4 of the Road Traffic Act
1988, for which there is no statutory “medical defence”:
5
Drug driving and the statutory "medical defence"
If you discuss the new offence and the statutory “medical defence” with your
patient, as prescriber or supplier of the medicine, or are questioned by patients on
this, you may find the following points useful in the discussion. If you provide
leaflets to your patients concerning their medicines you may also find the following
points useful when you are developing or updating these.

The police have new powers to test and prosecute drivers who are
suspected of driving having taken certain specified controlled drugs in
excess of specified levels in the body

Unlike the existing offence of driving whilst impaired by a drug, the new
offence has a statutory “medical defence” to protect those patients who
may test positive for certain specified drugs taken in accordance with the
advice of a healthcare professional or the patient information leaflet that
accompanies the medicine

It may therefore be helpful for patients to keep some suitable evidence
with them when they are driving that provides evidence that they are
taking the controlled drug as a medicine prescribed or supplied by a
healthcare professional or bought over-the-counter and taken in
accordance with the leaflet accompanying the medicine, in case that
patient was ever stopped by the police.

The patient may wish to choose carefully the evidence they plan to
provide if it were needed, so as to minimise the risk of sharing
particularly personal or sensitive information they would prefer to keep
confidential.

If the police are satisfied that a driver is taking the relevant medicine on
the advice of a healthcare professional or in accordance with the leaflet
that accompanies the medicine, the police will not prosecute them for
this offence.

However, it remains the responsibility of all drivers, including patients, to
consider whether they believe their driving is, or might be, impaired on
any given occasion, for example if they feel sleepy. It will remain an
offence, as now, to drive whilst their driving is impaired by drugs; and, if
in doubt, drivers should not drive. The statutory "medical defence" will
not be extended to be available for the existing ‘impairment’ offence
because even if legitimately taking a medicine, the patient should not be
driving if actually impaired.
6
Factors to consider when advising a patient as to
whether their driving is likely to be impaired
It is a driver’s responsibility to decide whether they consider their driving is, or they
believe might be, impaired on any given occasion.
It is the responsibility of prescribers and suppliers of medicines to give suitable
clinical advice to patients regarding the likely risks of their medicines as part of
their normal professional practice (including advice on serious and common sideeffects), which might include for example, for some drugs the advice that the drug
may cause sleepiness and so might impair driving.
Based on existing best practice, current advice given to patients about issues
related to ‘medicines and driving’ typically covers the following points, as relevant
to each case:

Not to drive if any symptoms or signs develop suggesting that their
driving may be impaired, such as experiencing sleepiness, poor
coordination, impaired or slowed thinking, dizziness, or visual problems.

Not to drive at certain times when the risk may be temporarily increased,
for example, when first starting, or when first increasing or reducing the
dose of, a medicine that may potentially impairing their driving

To take particular care in circumstances that may increase the risk of
their driving being impaired whilst taking their medicine, and to avoid
driving if this occurs. Such situations could include:
-
if another prescribed medicine is added that could also impair their
driving alongside the already potentially impairing medicine(s)
if they take an over-the-counter medicine that could also potentially
impair their driving if taken alongside the prescribed medicine;
if other medicines are being obtained from other prescribers that may
have an impact on their driving;
if there is a developing medical condition that could increase the risk of
the impairing side-effects from the prescribed medicine (for example,
during the development of a serious illness with recent marked loss of
weight);
if the patient takes any new medicines that are known to be able to
affect the metabolism of their existing medicine and so might impair their
driving; or
other relevant situations, such as the effects of age or the re-initiation of
a medicine that previously caused a period of sleepiness that impaired
driving.
To be aware that alcohol taken in combination with other impairing drugs
can substantially increase the risk of accidents.
-
-


A patient suffering with a condition that is being treated by a medicine
that is also one of the specified drugs for the new offence, should
normally still be encouraged to keep taking their prescribed medicine for
that clinical condition in accordance with the advice of the prescriber or
pharmacist. If the patient has been driving in line with such advice, and
7
has no reason to think themselves impaired to drive (for example, not
having developed new symptoms such as sleepiness), they can be
advised they will be entitled to raise the statutory "medical defence".
Alcohol
There is a body of evidence which shows that all of the drugs listed in the new drug
driving offence result in a significantly greater road safety risk when taken in
combination with alcohol, even in small amounts.
Other rules on fitness to drive
The new offence has been created in addition to the existing rules on reporting
medical conditions which affect fitness to drive to the Driver and Vehicle Licensing
Agency.
The latest information on the medical standards for driving in Great Britain and
Northern Ireland can be found online at www.gov.uk/government/publications/at-aglance.
The medical standards are reviewed regularly and are based on the minimum EU
standards for driving and the advice of the Secretary of State’s Medical Advisory
Panels.
Other sources of advice
More information on the drug driving legislation can be found online at
https://www.gov.uk/drug-driving-law
8